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Medical Procedures

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Medical Procedures

“When intervening becomes routine, meaning there is no reason for it, only risks remain” – Henci Goer

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Something to be aware of when heading away from a normal birth is the effect one intervention may have on your overall birth journey.  Often one intervention leads to another which in turn can lead to yet another.  This cascade effect is shown in the diagram below.

 

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Here's a brief description of the most commonly used medical procedures in labour and birth:

Induction of labour
 
What is it? 

  • An artificial way of beginning labour

 When is it necessary?

  • Used for post date pregnancies (more than 42 weeks)

  • For medical reasons e.g. pre-eclampsia, high blood pressure, diabetes, kidney disease

  • Waters break and labour doesn’t start

  • Placenta not working as efficiently as it was

  • Amniotic fluid levels low

  • A baby who is small for gestational age

How is it done? 

  • Stretch and sweep - LMC inserts fingers into the vagina, and then the cervix.  The cervix is gently stretched open, and the fingers 'swept' along to release the membranes of the amniotic sac from the cervix. This encourages the release of prostaglandins and oxytocin - the hormones required for labour.

  • Prostaglandin gel or pessary - A prostaglandin gel is applied around the cervix to help soften the cervix, but not used if membranes have ruptured. Dose can be repeated after 6 hours, to a maximum of three doses.

  • Artificial oxytocin (syntocinon) - an IV line is inserted into a vein in the back of the hand, and synthetic oxytocin (Syntocinon) is steadily released into the body via the drip until contractions are established.  The artificial oxytocin can be dialled up or down as needed. 

Advantages: 

  • A usually reliable means of bringing on labour when a woman or her baby’s health may be at risk 

Disadvantages: 

  • May mean a more painful and stressful labour

  • May lead to an increased need for pain relieving drugs

  • Other procedures more likely

  • Can lead to difficulty establishing breastfeeding due to the overriding of the body’s natural production of oxytocin

  • Strong contractions can lead to fetal distress

  • Increased chance of baby developing jaundice

  • Baby may have breathing difficulties and/or weak sucking reflex.


‘Natural’ Options for Induction
Note: Even these ideas are classed as interventions and so carry risk.
 

  • Birthing herbs or tonics from 34 to 36 weeks such as Pregnancy Prep 6-4-2.

  • Raspberry leaf tea – available as a loose leaf tea from a health food store.

  • Evening Primrose Oil – 1 or 2 capsules inserted in the vagina (close to the cervix every 8 to 10 hours.) Best time for insertion is in the late afternoon or early evening.

  • Nipple stimulation. One nipple at a time, 15 minutes each side.  You may use a gentle oil for lubrication.

  • Sex can also get things happening. It needs to be quality! – The pregnant woman needs to orgasm (oxytocin release) and a male partner's semen will add some prostaglandins to the mix which may help the cervix to soften and open.  Read more about the hormones of labour.

  • Homeopathy and acupuncture may also be useful. Must be carried out by a qualified practitioner.

  • Acupressure points can also be useful – check out this acupressure document. 

BEFORE EMBARKING ON ANY NATURAL INDUCTION METHODS PLEASE CONSULT YOUR LMC FIRST


Artificial Rupture of Membranes

What is it? 

  • Manually breaking the bag of waters.

When is it necessary? 

  • To assist induction of labour

  • To speed up labour which has started naturally (augmentation).

  • To check the colour of the amniotic fluid if fetal distress is suspected.

How is it done? 

  • LMC inserts fingers and amni hook through vagina and ruptures membranes to release fluids. Midwife will also leave fingers internally for a short time as there is a small risk of cord prolapse. 

  • A small nick is made in the membranes and the fluid is allowed to escape.

Advantages: 

  • May shorten labour (by up to an hour)

  • Can see colour of amniotic fluid

Disadvantages:

  • The cushioning effect of the waters is lost causing the baby’s head to press firmly on the cervix 

  • The intensity of the contractions may cause rapid dilatation and extra pain which may increase the need for analgesic drugs

  • Mother may suddenly experience transition without warning 

  • Increased risk of infection and puts time limits on length of labour

  • Risk of umbilical cord prolapse

  • May cause fetal distress


Ventouse

What is it?  

  • A vacuum cup that is inserted into the vagina and onto the baby’s head

  • Used to guide the baby down the birth canal

  • Invented in the 1950s

When is it necessary? 

  • Not usually used for premature or breech births

  • Used when mother is exhausted

  • Used when mother has heart disease

How is it done?

  • Mother lies on her back with legs in stirrups

  • A suction cup is applied to the baby’s head, and handles attached to the vacuum extractor can then be used to turn the baby and gently lift it out

  • The mother must push

Advantages:

  • Enables rapid birth

  • Cervix does not need to be fully dilated

  • Episiotomy is not usually required

  • Little to no internal bruising of the maternal tissues

  • Caesarean section may be avoided

Disadvantages:

  • Suction cup may fail to stay in place

  • Leaves a lump on baby’s head that may take a few hours/days to disappear

  • Baby may be distressed by suction or traction

  • Chance of retinal haemorrhage for baby

  • Can’t be used in prem, breech or face-first birth

  • Degree of force may misalign vertebrae resulting in an irritable baby- some parents choose to take baby to an osteopath / chiropractor following a forceps assisted birth


 
Forceps

What is it?  

  • Invented in the seventeenth century, forceps look a bit like a pair of large metal tongs. They are placed inside the vagina and around baby's head.

  • Normally involves an episiotomy as well.

When is it necessary? 

  • Forceps are used only during second stage of labour.

  • If baby is in an unfavourable position

  • If an epidural has left the mother unable to push

  • When baby is distressed and needs to be born quickly

  • When mother can’t push due to medical reasons or exhaustion

  • Often used if pushing is deemed to be going “too long” and baby is not progressing down the birth canal

How is it done? 

  • The cervix must be fully dilated

  • Mother is on her back with her legs supported in stirrups

  • An anaesthetic is administered, if an epidural is not already in place

  • The forceps blades are inserted one at a time and locked into position around the baby’s head

  • Baby is lifted out

Advantages: 

  • If baby is in an unfavourable position it might be the only way that a vaginal birth can be achieved

  • If pushing is not safe it allows baby to be born vaginally

  • Can be lifesaving if a distressed baby needs to be born quickly

Disadvantages: 

  • Episiotomy is normally required

  • Internal bruising and additional strain on pelvic floor 

  • May cause short term incontinence issues

  • May cause damage to vulva and vagina

  • Will need an episiotomy

  • May cause bruising to baby’s head

  • Temporary bruising or marks on baby’s face


Electronic Fetal Monitoring

What is it? 
An electronic way to monitor baby’s heart rate, contractions and baby’s reaction to them.

When is it necessary? 

  • When there are signs of fetal distress.

  • When mother has had an epidural

  • When labour is being induced.

How is it done? 

  • External monitoring uses two large elastic belts positioned around the abdomen. One holds a transducer which picks up the baby’s heartbeat, the other belt records the strength and length of the contractions.

  • Internal monitoring provides the same information, but with the use of an electrode attached to the baby’s scalp.

Advantages: 

  • Reassurance of condition of the baby 

  • Mother can visually monitor the labour if she has an epidural 

  • May enable early detection of potential risks to the baby’s health and well being during labour.

Disadvantages: 

  • Restricts movement

  • Internal monitoring requires early rupture of the membranes which could introduce infection and  may cause fetal distress

  • The machine may become the focus of attention rather than the mother

  • The effects of ultrasound in pregnancy have yet to be researched thoroughly

  • In a 2013 review featured in the Cochrane Library, it has again been concluded: “Continuous monitoring was associated with a significant increase in caesarean section and instrumental vaginal births. There was no difference in the incidence of cerebral palsy, however, other possible long-term effects have not been fully assessed and need further study.

Alternatives: 
If mother and baby are healthy and well then use of doppler is sufficient in most cases.


Caesarean Section


What is it?  

  • Done in a surgical theatre.  An incision is made into the abdomen, through to the uterus, and the baby is removed from the uterus and born through the abdominal wall.

  • Normally performed under an epidural anaesthetic. 

  • Elective or emergency

  • WHO recommends that only 10 – 15% of births are by c-section – In the1980’s approximately 9% of births were by caesarean section. now it''s 25 - 30% of births and rising

When might caesarean birth be done?

  • Pre-eclampsia

  • Fetal distress

  • Failure to progress in labour

  • Malpresentation

  • Prolapsed umbilical cord

  • Abruption of the placenta

  • Placenta praevia

  • Baby too big to fit through pelvis

  • Baby too small or growing poorly

  • Failed induction

  • Multiple pregnancy

  • Fetal abnormality

  • Baby in breech position

  • Previous caesarean section

  • Previous neonatal death

How is it done? 

  • Epidural, spinal anaesthetic or general anaesthetic is used

  • IV is sited

  • A drape is put up to screen the operating area

  • The pubic hair is shaved and the area cleaned

  • A catheter is passed into the bladder to keep it empty

  • An incision is made through the lower abdominal wall usually on the bikini line

  • The bladder is lifted back and the uterus is opened

  • The amniotic fluid is suctioned

  • The baby is lifted out, sometimes using forceps if the head is tightly wedged in the pelvic cavity

  • Syntometrine is administered to mother and the placenta is then removed

  • Surturing of all the layers is then done

 

Advantages: 

 

  • Can save the life of mother and baby

  • Use of epidural or spinal anaesthetics make it possible for mothers to be awake and aware during the birth to see and hear the baby born. This greatly facilitates bonding and post-operative recovery.

Disadvantages:

  • Abdominal surgery carries risks of damage to other internal organs and blood vessels

  • Lower fertility rates following Caesarean section

  • Feelings of disappointment for not delivering vaginally

  • Risk of infection

  • Longer hospital stay

  • Can interfere with establishing breastfeeding

  • Anaesthetic side effects

  • Baby may need extra observation or care

  • Baby more likely to have difficulties with breathing because of the absence of the stress hormones produced by the baby during a normal labour

  • Early separation of the mother and baby may interfere with bonding

  

Birth Plan | Being A Birth Goddess | Home Birth Essentials | Hormones In Labour
Informed Decision Making  |   Self Help Techniques
Stages Of Labour | Tips From A New Dad | What To Pack For Hospital

 

 


 

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